Dermal metastases reflect the ominous and aggressive spread of oropharyngeal squamous cell carcinomas. The rampant proliferation of these metastatic tumors to the neck results in respiratory distress and impending airway obstruction. We report a case of a patient with massive neck dermal metastases requiring urgent airway control for intermittent stridor. Awake tracheostomy is generally regarded as the gold standard to manage the compromised airway. However, in this unusual case, after discussion between surgeon and anesthesiologist, because of the anticipated formidable difficulties in performing awake tracheostomy, it was decided that awake fiberoptic intubation would provide the best chance of success.
From the *Departments of Anesthesiology & Perioperative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas.
†Head & Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas.
Accepted for publication March 28, 2018.
The authors declare no conflicts of interest.
Address correspondence to Angela T. Truong, MD, Department of Anesthesiology & Perioperative Medicine, University of Texas MD Anderson Cancer Center, 1400 Holcombe Blvd, Unit 409, Houston, TX 77030. Address e-mail to firstname.lastname@example.org.